Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 7793 | NM |
NPI | 1235524356 |
---|---|
Provider Name | Lisa Spirit Matteson |
First Address | Albuquerque, NM 87123-1746 |
Second Address | Albuquerque, NM 87123-1746 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2015 |
Last Update Date | 06/04/2015 |